One-in-Four Deaths in Pregnancy Due to HIV in Worst-Affected Countries

Researchers from the London School of Hygiene and Tropical Medicine report that the risk of pregnancy-related death is eight times higher for HIV-infected women than for uninfected women. In sub-Saharan countries with high HIV prevalence, one in four pregnancy-related deaths can be attributed to HIV. The study authors based their conclusions on a systematic review of 23 studies that had collected data on the risk of pregnancy-related death among uninfected and HIV-infected women.

Many of the 23 studies were conducted in areas of the world where a "verbal autopsy" from family members is the most common form of death report. Most of the HIV-infected women in the 23 studies were not taking antiretroviral therapy and were in an "advanced stage" of the disease. Little is known about the effects of HIV on pregnancy; it is not clear whether HIV causes more complications for pregnant women or whether pregnancy triggers the HIV progression.

The review compared death during pregnancy and the postpartum period among HIV-infected women and uninfected women to calculate the relative risk of death and the prevalence of HIV, and then used the pooled relative risk data from the meta-analysis to predict the effect of HIV on pregnancy-related death at the population level. This calculation method removes assumptions about HIV being related to or coincidental to pregnancy. Severe anemia and TB can cause maternal death and HIV-related death indirectly. Study authors suggest that future studies focus on identifying HIV-related deaths from "verbal autopsies."

Previous estimates of pregnancy-related death among HIV-infected women were not based on empirical data and did not distinguish between pregnancy-related deaths and maternal death that was incidental to the pregnancy.

The full report, "The Contribution of HIV to Pregnancy-Related Mortality: A Systematic Review and Meta-analysis," was published online in the journal AIDS (2013; doi: 10.1097/qad.0b013e32835fd940).